Does Vaccination Make ‘Long Covid’ Better or Worse? Here’s an Answer
How did COVID-19 survivors with persistent symptoms fare after COVID-19 vaccination? A UK study answers that question based on a single site study, finding that, while some symptoms improved and others worsened, overall, neither most symptoms nor quality of life were affected. Here are more details.
BRISTOL, UK – Should patients with so-called long COVID-19 receive a vaccine against future infection or would that just make lingering symptoms worse?
A UK study team at Southmead Hospital tackled that question, noting that some patients develop prolonged symptoms after acute SARS-CoV-2 infection. “Because the immunologic basis for this is unknown, uncertainty exists about whether vaccination against SARS-CoV-2 might worsen the associated symptoms,” the authors write in a letter to Annals of Internal Medicine. “Anecdotal reports have suggested both a potential benefit and worsening of symptoms after vaccination, with the uncertainty leading to vaccine hesitancy among some affected persons.”
Researchers sought to describe quality of life and symptoms after SARS-CoV-2 vaccination in a series of patients with persistent symptoms eight months after hospitalization with COVID-19.
Cases were identified from among 163 COVID-19 patients admitted to a UK hospital who had been admitted from December 2020 to January 2021. Every 12 weeks, researchers administered the Short Form-36 Health Survey (SF-36) and the Warwick–Edinburgh Mental Wellbeing Scale (WEMWBS) and performed a standardized review of ongoing symptoms.
They then identified participants who were symptomatic at eight months and who subsequently received the Pfizer-BioNTech (BNT162b2) or Oxford-AstraZeneca (ChAdOx1nCoV-19) vaccine between January and February 2021.
Participants were reassessed at about a month after vaccination, with quality-of-life questionnaires and review of symptoms repeated. The authors also asked specific questions on whether symptoms had improved, stayed the same, or worsened.
Of the 78 participants who attended the eight-month follow-up, 2 could not be contacted and 32 had not yet received a vaccine. Among the remaining 44 participants who had received one dose of vaccine, 36 (82%) reported at least one persistent symptom. The most common were, in order, fatigue, breathlessness, insomnia ENT symptoms, brain fog, muscle aches, anosmia, joint pain, cough, headache, heart palpitations, chest pain, diarrhea, abdominal pain and nausea.
Results indicated that participants had a high burden of persistent symptoms at eight months, with a median of four symptoms per patient (interquartile range [IQR], 2 to 5) and a total of 159 symptoms overall. A wide variety of symptoms were reported across multiple organ systems, with fatigue (75%), breathlessness (61%), and insomnia (53%) predominating, the authors point out.
“At this prevaccination time point, quality of life was markedly reduced from population norms, (with a median Mental Component Summary score of 40 (IQR, 29 to 51) and a median Physical Component Summary score of 35 (IQR, 25 to 40),” the study notes.
When participants were telephoned a median of 30 days after vaccination (IQR, 26 to 36 days) to gauge changes in symptoms and quality of life, 23.2% had improved, 5.6% had worsened, and 71.1% were unchanged, based on the 159 symptoms reported before vaccination.
“There was no significant worsening in quality-of-life metrics before versus after vaccination (t test P > 0.1 for all SF-36 comparisons),” according to researchers. “Mental well-being (as measured by the WEMWBS) was stable in vaccinated participants before and after vaccination (median, 49 [IQR, 42 to 54] vs. 50 [IQR, 40 to 59], respectively).”
On the other hand, 72% of the patients with persistent COVID-19 symptoms reported transient – less than 72-hour duration -- systemic effects after vaccination, including fever (44%), myalgia (22%), and headache (19%). The authors explain, “This is consistent with other observational studies of vaccine adverse effects in persons with previous SARS-CoV-2 infection.”
Despite limitations, the researchers write that their “observations may provide reassurance to the increasing number of persons experiencing long-term symptoms after acute SARS-CoV-2 infection that receipt of a messenger RNA or adenoviral vector vaccine is not associated with a decrease in quality of life or worsening of symptoms. Further work that includes appropriate unvaccinated controls is needed to confirm the trajectory of persistent symptoms after COVID-19 vaccination.”
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